Page last updated: 24-JUN-2008

General Practice - Quality & Outcomes Framework

2007/08 - Prevalence Rates for Scotland       ONS kitemark

Introduction

This page presents data on the reported national prevalence of the individual diseases or conditions within the clinical domain of the Quality & Outcomes Framework (QOF) for the years 2004/05 to 2007/08, as at 14th February - "National Prevalence Day".  For 2004/05-2006/07, final figures are shown (based on signed-off, verified data).  Added to these are initial figures for 2007/08 (based on calculations done within the QOF data management system (QMAS) to support payments to practices).  Prevalence data collected from QOF 'registers' forms an integral part of the framework which determines the level of payment to individual practices.  Please refer to  Prevalence data in the QOF to find out why prevalence is important and how it is used in the calculation of QOF payments.

Final figures for 2007/08 may differ slightly from the ones shown here for some registers.  This is because figures for some individual practices may not have been available for technical reasons when the initial calculations were run, or may need to be revised.

A number of revisions were implemented to the QOF in April 2006, most significantly affecting the clinical domain. Revised definitions were implemented in specific areas and a number of entirely new clinical areas were introduced. No clinical areas were dropped from the framework, although specific individual indicators may no longer exist or may have been redefined. Furthermore, new indicators were introduced in some areas.

Further information on changes to the QOF for 2006/07-2007/08 can be found in the guidance for Scotland   (PCA2006(M)13 ). There are no changes to QOF for 2007/08 so the clinical areas are consistant with those in 2006/07.

QOF registers for seven clinical areas have maintained a consistent definition since April 2004. Comparable prevalence statistics across the first 4 years of the framework have been provided in these areas: Asthma, Cancer, Coronary Heart Disease, Chronic Obstructive Pulmonary Disease (COPD), Hypertension, Hypothyroidism and Stroke and Transient Ischaemic Attack (TIA).

QOF registers for four clinical areas maintained a consistent definition between 2004/05 and 2005/06 but were subject to revision for 2006/07. Prevalence statistics for these areas are not directly comparable across all years: Diabetes Mellitus, Epilepsy, Left Ventricular Dysfunction and Mental Health.

The remaining QOF registers were new to the QOF for 2006/07 and have retained a consistant definition in 2007/08 so prevalence can be compared over 2 years : Atrial Fibrillation, Chronic Kidney Disease, Dementia, Conditions Assessed for Depression, Heart Failure, Learning Disabilities, Obesity, Palliative Care and Conditions Assessed for Smoking.

Additional information on the prevalence of long-term conditions can be found in 'Measuring Long-Term Conditions in Scotland - A summary report'.

Summary Information

The following table presents Scotland level prevalence by clinical area and year.  The full list of clinical areas has been categorised according to whether the register definitions are unchanged, revised, or were new for 2006/07.

QOF National Prevalence Day1 Summaries by Register and Year (April-March)
Estimated national prevalence rates per 100 patients registered with general practices2,3,4;
Scotland 2004/05-2007/08

Click on the specific register name for more detailed information and interpretation.

 

2004/05
(final)

2005/06
(final)

2006/07
(final)

2007/08
(initial)
Unchanged Registers

Asthma
Cancer
Coronary Heart Disease
COPD
Hypertension
Hypothyroidism
Stroke and TIA

5.4
0.5
4.5
1.9
11.5
2.8
1.8

5.4
0.7
4.5
1.8
12.0
3.0
1.9

5.5
0.9
4.5
1.8
12.5
3.1
2.0

5.5
1.1
4.5
1.8
13.1
3.2
2.0
Redefined Registers

Diabetes Mellitus
  Register in 2004/05 and 2005/06        
  Register in 2006/07
Epilepsy
  Register in 2004/05 and 2005/06
  Register in 2006/07
Left Ventricular Dysfunction
  Register in 2004/05 and 2005/06
  Register in 2006/07
Mental Health
  Register in 2004/05 and 2005/06
  Register in 2006/07


3.2
-

0.7
-

0.6
-

0.5
-


3.4
-

0.7
-

0.6
-

0.6
-


-
3.5

-
0.7

-
0.6

-
0.8


-
3.7

-
0.7

-
0.6

-
0.8

 
New Registers
(rates in 2006/07 and 2007/08 not directly comparable with earlier ones)

Atrial Fibrillation
Chronic Kidney Disease
Dementia
Registers for Depression Indicators
  Conditions for Depression Screening   
  Diagnosis of Depression
Heart Failure
Learning Disabilities
Obesity
Palliative Care
Conditions Assessed for Smoking

-
-
-
 
-
-
-
-
-
-
-

-
-
-
 
-
-
-
-
-
-
-

1.3
1.8
0.6
 
7.2
6.2
0.9
0.4
7.0
0.1
20.4

1.3
2.5
0.5
 
7.4
6.1
0.9
0.6
7.4
0.1
22.4

Data Source: QMAS Database
Excel version of this table excel download icon (22 Kb) also available for download

Notes:

  1. National Prevalence Day - 14th February in each year: 2005/06/07/08. See  Prevalence data in the QOF for more information.
  2. 2004/05, 2005/06 and 2006/07 prevalence figures have been calculated using register submissions from practices.  The 2007/08 figures are the prevalence rates initially calculated within the QMAS system in order to to calculate adjustments for payment.  Final figures for 2007/08 will be published as part of ISD?s full report on the QOF for 2007/08 on 30th September 2008.
  3. Rate calculations use practice list sizes as at 1st January in each year, obtained from the Community Health Index (CHI).  All QOF prevalence rates are calculated using the whole practice population, with no restriction for age, even if the registers themselves are age-restricted.
  4. An excel version of this table excel download icon(22 Kb), containing additionally the initial figures for 2004/05-2006/07, is also available to be downloaded from this link.

Detailed Information and Interpretation

Asthma

The prevalence statistics provided here are based on registers that have been constructed annually by searching for patients with a diagnosis of asthma, excluding those who have had no prescription for asthma-related drugs in the last 12 months.  Asthma remains a clinical area under the QOF, having been included in the framework from its first year, 2004/05. The current definition is consistent with previous definitions used since 2004/05.  The reported national prevalence rate of 5.4% in 2004/05 and 2005/06 rose slightly to 5.5% for each of 2006/07 and 2007/08.  The increase may have been due, at least in part, to improved case ascertainment by practices over time.

More information on why asthma was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of asthma in Scotland (including consultation rates in general practice in 2003/04 to 2006/07) is available on ISD's Practice Team Information (PTI)  web pages.

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Atrial Fibrillation

Atrial fibrillation is a heart rhythm disorder.  The definition applies to people with an initial event; paroxysmal (intermittent); persistent and permanent. Note that this register was introduced to the QOF in April 2006 so there are only 2 years of comparable data. The QMAS system reports a national prevalence of Atrial Fibrillation as at 14th February 2008 of 1.3%, the same as the prevalence as at 14th February 2007.

More information on why atrial fibrillation was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

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Cancer

The QOF prevalence statistics provided are based on all cancers except non-melanomatous skin lesions but include only patients diagnosed after 1st April 2003. The current definition is consistent with previous patient selections used since 2004/05.   National prevalence reported under the QOF has shown an increase from 0.5% in 2004/05 to 1.1% in 2007/08. Because of the date cutoff, this rise reflects the accrual of new cases with each passing year rather than giving any indication of a true increase in cancer prevalence.

More information on why cancer was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of cancer in Scotland is available on the following websites:

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Coronary Heart Disease

Coronary Heart Disease has remained a clinical area within the QOF, with consistent selection criteria, since QOF implementation in 2004/05. The QMAS system has reported a stable national prevalence of 4.5% as at national prevalence day (14th February) in each of the first four years of the framework.

More information on why coronary heart disease was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of CHD in Scotland is available on the following websites:

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Chronic Kidney Disease

The QOF indicators for Chronic Kidney Disease (CKD) are based on a practice register of people aged over 18 with chronic kidney disease from any cause. Inclusion in the register is based on estimated Glomerular Filtration Rate (eGFR), a measure of kidney function.  Those whose kidney function is assessed at stage 3-5 based on this test are eligible for inclusion on the register. Note that this register was introduced to the QOF in April 2006 so there are only 2 years worth of data available. 

For 2006/07 the final reported prevalence rate was 1.8%, much lower than a true figure expected to emerge over time.   The establishment of CKD registers in Scotland was dependent on the existence of systems to support eGFR testing.  Unfortunately, in some areas there were delays in introducing eGFR testing and as a result fewer patients than expected were included on CKD registers. The final reported prevalence rate for 2006/07 is therefore likely to be an underestimate of the true figure.

For 2007/08 the initial reported prevalence has risen to 2.5%.  This increase is likely to be due largely to improvements in case ascertainment, supported by the improved availability of eGFR testing in Scotland.

More information on why Chronic Kidney Disease was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of chronic kidney disease in Scotland is available on the following website:

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Chronic Obstructive Pulmonary Disease (COPD)

COPD has remained a clinical area within the QOF, with consistent selection criteria, since QOF implementation in 2004/05. The QMAS system has reported a stable national prevalence as at national prevalence day (14th February) in each of the first four years of the framework: 1.9% in 2004/05 and a slightly lower figure of 1.8% in 2005/06, 2006/07 and 2007/08.

More information on why COPD was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the prevalence of COPD in Scotland is available on ISD's Practice Team Information (PTI)  web pages.

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Dementia

The definition applies to all people diagnosed with dementia either directly by the GP or through referral to secondary care. This register was introduced to the QOF in April 2006 and there are no directly comparable statistics available for previous years. The final national prevalence figure calculated for 2006/07 was 0.6%, whereas the initial figure for 2007/08 is only 0.5%.  This seems contrary to expectations that further case ascertainment over time may lead to increases in reported prevalence rates of dementia from QOF registers.  However, the final figure for 2007/08 may differ from the 0.5% reported initially.

More information on why dementia was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of dementia in Scotland is available on ISD's Practice Team Information (PTI)  web pages.

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Depression

Since 2006/07 there have been two different QOF registers related to depression, each based on different criteria. The first register relates to case finding of depression among diabetes and CHD patients and the second indicator to any patient newly diagnosed with depression since 1st April 2006.  Both were introduced to the QOF in April 2006 and there are no directly comparable statistics available for previous years in either case.

The register for the depression 1 indicator counts patients with diabetes and/or CHD.  The indicator then measures whether patients with either or both of these conditions have been assessed for depression.  Nationally, 7.2% of patients registered to general practices at 14th February 2007 had either diabetes, or CHD, or both ? this rose to 7.4% at 14th February 2008.  This can be explained largely by a rise in the prevalence figures for diabetes from 3.5% to 3.7% over the same period.

The register for the depression 2 indicator counts patients with newly diagnosed depression.  The indicator then measures whether the severity of the depression has been assessed, using an assessment tool validated for use in primary care.  An unusual feature has been noted within QMAS in relation to the register sizes returned for this indicator. Although the measurement of achievement against this indicator excludes patients diagnosed prior to 1st April 2006, the pre-exclusion register size is used for prevalence purposes. For some practices with a long history of recording depression electronically in the clinical record (and where the depression is not recorded as having been resolved), a larger register size will be reported in comparison to an otherwise equivalent practice that has not been recording depression cases electronically over as long a time period. Prevalence rates are unaffected in the majority of cases, and the small numbers of practices that have been more significantly affected are not expected to unduly bias the overall national prevalence figure.  The final figures for 2006/07 indicated that nationally 6.2% of patients registered to general practices at 14th February 2007 had been newly diagnosed with depression.  Initial figures for 14th February 2008 stand at 6.1%.  This drop, although small, is perhaps surprising.  The final figure, once all practice submissions have been validated, may differ.

More information on why depression was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of depression in Scotland is available on ISD's Practice Team Information (PTI)  web pages.

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Diabetes Mellitus

Although indicators related to Diabetes Mellitus have existed in the QOF since April 2004, there has been a change in the selection criteria for eligible patients. Since April 2006, the definition includes all patients aged 17 years and over with diabetes mellitus defined by clinical (Read) codes specific to Type 1 or Type 2 diabetes. Previously there was a wider range of codes accepted under the definition although the age constraint has remained consistent. The prevalence statistics for 2006/07 and 2007/08 are therefore not directly comparable with those for 2004/05 and 2005/06.  It should also be noted that QOF prevalence rates use the whole practice population as their denominator, and do not exclude patients aged less than 17.  This means that the prevalence rates reported for diabetes are lower than they would be if this age group was excluded.

QMAS reports that prevalence of Diabetes Mellitus has increased from 3.5% at 14th February 2007 to 3.7% at 14th February 2008. This increase may be due, at least in part, to improved case ascertainment by practices.

It should be further noted that although the practice must record whether the patient has Type 1 or Type 2 diabetes, this level of detail is not recorded within QMAS (the national IT system that supports the calculation of QOF achievements and payments). Therefore the register size or prevalence rate cannot be split by type of diabetes.

More information on why diabetes mellitus was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of diabetes in Scotland is available on the following websites:

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Epilepsy

Although indicators for Epilepsy have existed in the QOF since April 2004, there has been a change in the selection criteria for eligible patients. Since April 2006, the definition has included patients aged 18 and over, whereas previously it was 16 and over.  It should be noted that QOF prevalence rates use the whole practice population as their denominator, and do not exclude patients aged less than 18 (or 16). This means that the prevalence rates reported for epilepsy are lower than they would be if this age group was excluded.

The prevalence statistics for 2006/07 and 2007/08 are therefore not directly comparable with those for 2004/05 and 2005/06.  Between 14th February 2007 and 14th February 2008 there has been no change in the QMAS prevalence rate for Epilepsy with both years showing a rate of 0.7%.

More information on why epilepsy was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of epilepsy in Scotland is available on the following websites:

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Heart Failure

To cover indicators relating to heart failure, one new register was introduced in April 2006 and a revision was made to one other. Heart Failure therefore, in common with depression, is a clinical area that requires prevalence reported on multiple registers. The first register relates to patients selected using full heart failure diagnostic criteria and the second relates to a subset of these patients defined as having heart failure with left ventricular dysfunction (LVD). The broader category of heart failure was new to the QOF in 2006/07 but LVD was included in the previous QOF, although as part of a different definition. Previously the register related to patients on the coronary heart disease register with LVD. LVD was a subset of CHD in previous years, but all these patients are now subsumed into heart failure registers.

National reported prevalence of heart failure as at both 14th February 2007 and 14th February 2008 was 0.9%. The prevalence statistics for left ventricular dysfunction (LVD) are presented for each of the last four years but those for 2006/07 and 2007/08 are not directly comparable with those for 2004/05 and 2005/06.  There is no change in the LVD prevalence between 14th February 2007 and 14th February 2008 with both years showing an overall rate of 0.6%.

More information on why heart failure was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

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Hypertension

Hypertension has remained a clinical area within the QOF, with consistent selection criteria, since QOF implementation in 2004/05.  The final national prevalence figure for 2005 was 11.5%, and this has risen since to an initial figure of 13.1% for 2008. This increase may be due, at least in part, to improved case ascertainment by practices over time.

More information on why hypertension was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of hypertension in Scotland is available on the following websites:

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Hypothyroidism

Hypothyroidism has remained a clinical area within the QOF, with consistent selection criteria, since QOF implementation in 2004/05. The QMAS system has reported national prevalence rising from 2.8% on national prevalence day 2005 to 3.2% as at national prevalence day 2008. This increase may be due, at least in part, to improved case ascertainment by practices over time.

More information on why hypothyroidism was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of hypothyroidism in Scotland is available on ISD's Practice Team Information (PTI) web pages.

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Learning Disabilities

This register applies to all people aged 18 and over with learning disabilities. Note that this register was introduced to the QOF in April 2006 and that there are no directly comparable statistics available for previous years. It should be noted that QOF prevalence rates use the whole practice population as their denominator, and do not exclude patients aged less than 18. This means that the prevalence rates reported for learning disabilities are lower than they would be if this age group was excluded.

The reported national prevalence of Learning Disabilities as at 14th February 2007 was 0.4%.  This rose to 0.6% for 14th February 2008.  This is lower than estimates of overall population-based prevalence given in QOF guidance (around 2% across all ages).  However, not all such persons are known to general practices.

More information on why learning disabilities were included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on learning disabilities is available on the following websites:

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Mental Health

Although indicators for Mental Health have existed in the QOF since April 2004, there has been a change in the selection criteria for eligible patients. Since April 2006, the definition has included only patients with serious mental illness, defined as schizophrenia, bipolar affective disorder or other psychoses.  Previously, patient selection was based on more a more generalised set of mental health conditions and on the further condition that the patient required, and had consented to, regular follow-up. The prevalence statistics for 2006/07 and 2007/08, though comparable with each other, are not directly comparable with those for 2004/05 and 2005/06.

On comparing rates from national prevalence day in 2007 to those for national prevalence day in 2008, it is seen that there is no change, with both years showing a rate of 0.8%.

More information on why mental health was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of mental health problems in Scotland is available on the following websites:

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Obesity

The definition of obesity used for the QOF applies to all people aged 16 years and over with a BMI of at least 30 (that is greater than or equal to 30kg per height in metres squared), recorded in the previous 15 months. Note that this register was introduced to the QOF in April 2006 and that there are no directly comparable statistics available for previous years.

The final QOF-reported national prevalence of obesity as at 14th February 2007 was 7.0%.  For 2007/08 the initial figure was 7.4% as at 14th February 2008.  Both figures are lower than the generally accepted rates of over 20% as shown elsewhere (for example, those summarised by the Scottish Public Health Observatory (ScotPHO) at www.scotpho.org.uk).  Some of this will be due to the fact that QOF prevalence rates use the whole practice population as their denominator and do not exclude patients aged less than 16, meaning that the prevalence rates are lower than they would be if this age group was excluded from the population denominator.  However, this will not account for a great deal of the difference.  Another likely reason is that not all persons who are definitionally obese may necessarily be recorded as such by general practices, for example if they are relatively young and have not experienced any particular health-related difficulties.  However, there is likely to be scope for case ascertainment of obesity by practices to improve over time.

More information on why obesity was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on obesity is available on the following websites:

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Palliative Care

The definition of the palliative care register applies to all people aged 18 years and over in need of palliative or supportive care. Note that this register was introduced to the QOF in April 2006 and that there are no directly comparable statistics available from this source for previous years. It was decided not to apply the prevalence factor adjustment (refer to  Prevalence data in the QOF ) as the numbers might vary considerably throughout the year. This figure only tells you how many patients were on the register on 14th February 2007 or 2008 so it may not be a true reflection of practice prevalence throughout the rest of the year. The QMAS system reports a national prevalence of patients requiring palliative care as at both 14th February 2007 and 14th February 2008 of 0.1%.

More information on why palliative care was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

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Conditions Assessed for Smoking

The register to support two "new" smoking indicators (actually a reworking of several smoking indicators included in the original QOF) was introduced to the QOF in April 2006. However it is important to stress that a national prevalence of smoking cannot be derived from this register or previous indicators. The current indicators relate to the smoking status of people with one or more selected chronic conditions. The register definition applies to people with any of the following conditions: coronary heart disease, stroke or TIA, hypertension, diabetes, COPD or asthma.

As the register was introduced to the QOF in April 2006, there are no directly comparable statistics available from this source for previous years. The reported  national prevalence of the listed chronic conditions as at 14th February 2007 was 20.4% - that is to say, 20.4% of patients registered to general practices had one or more of those conditions.  The initial figure as at February 14th 2008 is 22.4%.  This increase is likely to be influenced at least in part by an increase in the recorded prevalence of hypertension.

More information on smoking indicators within the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on smoking is available on the following websites:

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Stroke and Transient Ischaemic Attack

Stroke and TIA has remained a clinical area within the QOF, with consistent selection criteria, since QOF implementation in 2004/05. Reported national prevalence has risen from 1.8% on national prevalence day 2005 to 2.0% as at national prevalence day 2008. This increase may be due, at least in part, to improved case ascertainment by practices over time, particularly during the first two years of the QOF.

More information on why stroke and TIA was included in the QOF is available in the following documents:

Links to QOF Business Rules (contains the technical requirements for selecting the appropriate register):

Further information on the occurrence of stroke in Scotland is available on the following websites:

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Main contact: Email Alistair Smith